HomeMy WebLinkAbout1985-07-26 Application for Well PermitCITY OF ORON%" APPLICATION FOR UTILITY PERMITS
Box 66 (1335 Brown Road So) SEWER WATER. WELL
Cry:;tal Bay, MN 55323
General Instructions
1. You may apply for utility permits by mail or in person at the City offices.
1. Mai loci in applications are subject to the postage and handl rng fees shown below. Permit ca
he sent by return mail the same day the application is received.
1. Permits are not valid until you receive a permit card.
4. Work must not begin unless the permit cord is available on the job site.
5. Utility connection permits may be issued to licens^d cuntractors only.
t. :.:act the City offices for utility stub as -built locations. DO NOT EXCAVATE IN ANY STR
NOT TAP ANY MAIN without express approval of the Public Works Department. Issuance of
does not grant this approval.
7. All work must be dune in accordance with State Code requirements.
S. All work must be inspected before it is covered. Call 473-7357.
JOB SITE ADDRESS
Occupancy Type:__C� Resi
OWNER'S NAME a
Mailing Address
CONTRACTOR'S NAME _ i cl
Mailing Address
dentia
o
ommercia
Telephone No. -01
Business No. - Ll.
State License No. ,Z2011-76" City Cert. No.
PERMIT TYPE AND FEE CALCULATION
MUNICIPAL SEWER CONNECTION ($30 per stub) $
ripe size inches; material PVC (on sand fill);
cast iron
Charge ($425.00) must accompany all sewer permit applications unless
I:,•id. If not prepaid, a sewer connecticn permit will not be issued.
CIPAL WATER CONNECTION ($30 per stub) $
r.i:e inches; material copper
_.t,_
WATER METERS must lie picked up and paid for at City Hall.
(5/8" meters = $95.00 3/4" meters = $130.00)
PRIVATE WELL INSTALLATIONS ($30 per job)
check: I_ new well replacement well
repair existing well
casing size: # _inches
REQUIRED minimum setbacks from drainfield & septic tanks = 75'
CALL IFR A SITE LOCATION BEFORE DRILLING
Upon completion, City must be sent a copy of state well record.
1. Subtotal of above permit requested $_
2. State Surcharge $ .50
The State Building Code Division Surcharge of $.50 per permit n,, ,t be includr_d for
cac•h well, sewer and water connection permit requested.
). 5C'
3. Postage and Handling (Only mail -in applications)
4. TOTAL PERMIT FEE (Add lines 1-3 above) $ f
The undersigned hereby applies to the City of Orono for issuance of a UTILITY
PERMIT, agrees to do all work in strict accordance with the ordinances of the City
-' _ _. z, ' at :ens of the State of Minnesota, and certifies that all statements
f,r; this application are complete, true and correct.